Provider Demographics
NPI:1891359774
Name:PRATTS, WANDA IVELISSE (TF)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:IVELISSE
Last Name:PRATTS
Suffix:
Gender:F
Credentials:TF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 01 BOX 6146
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-9713
Mailing Address - Country:US
Mailing Address - Phone:787-462-6041
Mailing Address - Fax:
Practice Address - Street 1:RAMAL 926 KM 2.4 BO COLLORES
Practice Address - Street 2:
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771-9713
Practice Address - Country:US
Practice Address - Phone:787-462-6041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist